Healthcare Provider Details

I. General information

NPI: 1508925868
Provider Name (Legal Business Name): WANDA I TORRES-LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSP CALLETANO COLL T TOSTE SUITE 105 CARR 129 AVE SAN LUIS
ARECIBO PR
00613
US

IV. Provider business mailing address

PO BOX 3384
GUAYNABO PR
00970-3384
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-7272
  • Fax: 787-848-0318
Mailing address:
  • Phone: 787-878-7272
  • Fax: 787-848-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number12447
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: